Nokea
Priority nursing diagnoses for Mrs. Q (Breech presentation):
- A. Risk of uterine rupture, risk of fetal distress, pain
- B. Risk of infection, risk of fetal distress, risk of preterm birth
- C. Risk of hemorrhage, risk of cord prolapse, pain
- D. Risk of fetal malpresentation, impaired maternal coping
Correct Answer: A
Rationale: Nursing diagnoses include risks of uterine rupture, fetal distress, and pain management.
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Vaginal birth after caesarean section is known as
- A. Spontaneous vaginal delivery
- B. Trial of scar
- C. Spontaneous vertex delivery
- D. Trial of birth
Correct Answer: B
Rationale: Vaginal birth after cesarean is known as a trial of scar.
What are the signs of uterine rupture during labor?
- A. Sudden abdominal pain
- B. Loss of fetal heart tones
- C. Vaginal bleeding
- D. All of the above
Correct Answer: D
Rationale: Uterine rupture is life-threatening and has multiple warning signs.
M. T. is a 71-year-old female who presents for evaluation of a lump on her chest. She denies any symptomsthere is no pain, erythema, edema, ecchymosis, or open areasit is just a lump. She has no idea how long it has been there and just noticed it a few weeks ago. Physical examination reveals a round, smooth, flesh-colored tumor. It is firm but not hard it has smooth borders. It measures 6 cm in diameter and is non-tender to palpation. The AGACNP suspects that this is a classic presentation of the most common chest wall tumor known as a
- A. Neurolemma
- B. Lipoma
- C. Hemangioma
- D. Lymphangioma
Correct Answer: D
Rationale: The described presentation of a round, smooth, flesh-colored tumor that is firm but not hard, with smooth borders, non-tender to palpation, and measuring 6 cm in diameter, fits the classic presentation of a lipoma. Lipomas are common noncancerous soft tissue tumors often found just beneath the skin, can occur anywhere on the body, including the chest wall. They are usually painless and slowly growing, with a characteristic appearance of being smooth, soft, and mobile under the skin. In this case, the absence of pain, redness, swelling, or other concerning signs, along with the appearance and characteristics of the lump, are highly suggestive of a lipoma.
R. S. is a 66-year-old female with Cushings syndrome due to an ACTH-producing pituitary tumor. The tumor is readily isolated by imaging, and the patient had an uneventful surgery. When seeing her in follow-up, the AGACNP anticipates
- A. Rapid reversal of symptoms, with good pituitary function
- B. Transient rebound release of remaining pituitary hormones
- C. Markedly improved dexamethasone suppression test
- D. Hyponatremia and compensatory SIADH
Correct Answer: A
Rationale: In patients with Cushing's syndrome due to an ACTH-producing pituitary tumor, removal of the tumor can result in a transient rebound release of remaining pituitary hormones. This occurs because the suppressed pituitary gland begins to recover and overproduce hormones in response to the sudden decrease in negative feedback from the removed tumor. As a result, patients may experience transient hormonal fluctuations before the pituitary gland establishes a new equilibrium. Therefore, when seeing the patient in follow-up after surgery, the AGACNP should anticipate a transient rebound release of remaining pituitary hormones rather than immediate and rapid reversal of symptoms or markedly improved test results. Additionally, hyponatremia and compensatory SIADH are less likely in this scenario unless there are other underlying factors contributing to it.
A patient being monitored post-heart transplant suffers a bradyarrhythmia. The AGACNP knows that which of the following medications is not indicated as part of emergency intervention for bradycardic abnormalities in a posttransplant patient?
- A. Isoproterenol 0.2 to 0.6 mg IV bolus
- B. External pacemaking
- C. Atropine 0.5 mg IV
- D. Epinephrine 1 mg IV
Correct Answer: A
Rationale: Epinephrine is not indicated as part of emergency intervention for bradycardic abnormalities in posttransplant patients. Epinephrine is a medication usually used in cases of cardiac arrest or severe anaphylaxis, and it can potentially exacerbate bradycardia in patients with preexisting bradyarrhythmias. In this scenario, other options such as isoproterenol, external pacemaking, and atropine are more appropriate choices for managing bradyarrhythmias in a posttransplant patient.